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EBMT 2025 | Sequencing cellular therapy strategies in LBCL as the treatment landscape evolves
In this video, Alberto Mussetti, MD, Institut Catala d’Oncologia Hospitalet, Barcelona, Spain, comments on the sequencing of cellular therapy strategies in patients with large B-cell lymphoma (LBCL), noting that the increasing use of anti-CD19 CAR T-cell therapy in the second line of treatment is changing the approach to further relapse. Dr Mussetti highlights that many unanswered questions about the sequencing of non-CAR T-cell-based therapies after second-line CAR-T remain and must be addressed as the therapeutic landscape evolves. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
So when we are talking about cellular therapy for LBCL, we are witnessing a paradigm shift in this setting. In fact, we started with the use of anti-CD19 CAR T-cell in the third line of therapy or further lines of therapy. But now we are witnessing that almost half of these patients with high-risk disease will receive such therapy in the second line of therapy.
So if you anticipate the use of anti-CD19 CAR T-cell therapy as a second line of therapy, the way you should treat further relapse in this setting is completely changing, because you don’t know how to sequence all the other non-CAR T-cell-based therapies in this setting...
So when we are talking about cellular therapy for LBCL, we are witnessing a paradigm shift in this setting. In fact, we started with the use of anti-CD19 CAR T-cell in the third line of therapy or further lines of therapy. But now we are witnessing that almost half of these patients with high-risk disease will receive such therapy in the second line of therapy.
So if you anticipate the use of anti-CD19 CAR T-cell therapy as a second line of therapy, the way you should treat further relapse in this setting is completely changing, because you don’t know how to sequence all the other non-CAR T-cell-based therapies in this setting.
And also we should also remember that allogeneic transplantation or also autologous stem cell transplantation, which is now used less, more since the arrival of anti-CD19 CAR T-cell therapy in second-line therapy, these are still therapeutic strategies that we don’t really know how to apply in this context.
So things are evolving and of course for good in the sense that we have more therapeutic strategies for such patients. But we still have issues especially with patients who are refractory not just to chemotherapy but also to newer immunotherapies such as CAR T-cell therapies in second-line therapies or third-line therapies.
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Disclosures
Honoraria for lectures: Takeda, BMS, Gilead, Sanofi; Honoraria for advisory board activities: Merck, Jazz Pharma; Participation in clinical trials (PI): Atara, Takeda; Research funding: Gilead.
